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epf surgery

Posted by milley on 8/12/04 at 09:03 (157662)

I had surgery epf 4 months ago then two weeks later I developed a nodule or fatty tumor that was removed still no relieve and no weight bearing. My ct scan shows 'spur plantar aspect of the calcaneus' what does this mean.

Re: epf surgery

Dr. Z on 8/12/04 at 11:44 (157689)

Hi

With an EPF procedure the plantar fascia is released, not the boney spur. There is usually no relationship between the pain and the spur with the pain coming from a degeneration of the plantar fascia This is called a plantar fasciosis.
EPF procedures can be painful, take a very long time for pain resolution and in some cases leave the foot painful. Good idea to get off the foot at this stage. May want a second opinion

Re: epf surgery

Pauline on 8/12/04 at 15:32 (157700)

Dr. Z,
Are plantar fasciitis and plantar fasciosis two different conditions then? If a person has the fasciosis (degeneration) is the treatment the same or is there nothing that can be done? I'm not certain that we all know the difference. Maybe the long term P.F. sufferers have the
fasciosis one and thats why they don't get better.

Re: epf surgery

Dr. Z on 8/12/04 at 15:53 (157702)

Pauline

Here is an abstract that explains the difference.

http://www.eswtusa.com/files/tendonosisreport.pdf

Re: epf surgery

milley on 8/12/04 at 17:25 (157710)

i have been on bed rest and cruths for two weeks now still no relieve except when it goes numb>

Re: epf surgery

milley on 8/12/04 at 17:27 (157711)

thats a great question I was wonderinng that myself?

Re: epf surgery

Ed Davis, DPM on 8/13/04 at 14:36 (157765)

Pauline:
Your last sentence was right on the mark. The concept of plantar fasciosis is just beginning to be understood -- it is a tissue quality issue and the reason that a number of PF sufferers have a hard time getting better.
Ed

Re: epf surgery

Pauline on 8/13/04 at 16:32 (157776)

Dr. Ed,
Perhaps the deterioration can be attributed to the steroid injections that are so often tried. I wouldn't be surprised that they do play a part in this.

Re: epf surgery

Ed Davis, DPM on 8/13/04 at 18:32 (157784)

Pauline:

There are two causes of fasciosis. First, long term inflammation -- our bodies seem to handle chronic inflammation very poorly. One way if viewing ESWT is that it converts chronic inflammation to acute inflammation which our body responds to very well by bringing in cells that break down pathologic tissue, revasculariztion and so forth. This is the main thing.

Some of the toughest cases of PF are those patients who have had all the necessary components of PF ignored but given multiple cortisone shots. One often sees this coming from HMO's where they are giving patients a lot of palliative care and avoiding specialist referrals.
Ed